AMC, Academic Medical Center; aOR, adjusted odds ratio; CI, confidence interval; CINIMA, Center for Infection and Immunology Amsterdam; DAG, directed acyclic graph; HIV, human immuno-deficiency virus; i.e., id est, it's, for example; IQR, interquartile range; MEC, Medical Ethics Committee; MSM, men who have sex with men; OR, odds ratio; RIVM, National Institute of Public Health and the Environment, Centre for Infectious Disease Control; STI, sexually transmitted infection; UAI, unprotected anal intercourse; UMCU, University Medical Center Utrecht
New research should remain up-to-date as it pertains to fast changing dating processes as well as sero-adaptive behaviours (like viral sorting and pre exposure prophylaxis). With every new way of dating and preventive opportunities, the rules of engagements will be different. Our data are 8years old and web-based dating has developed since then. However these results are useful, as they demonstrate how net-based partner acquisition can lead to more information on the sex partner, and this may affect on the frequency of UAI.
Dating online may offer other chances for communication on HIV status than dating in physical environments. Free Fuck Book near Rozelle, NSW. Easing more on-line HIV status disclosure during partner seeking makes serosorting easier. Yet, serosorting may increase the weight of other STI and will not prevent HIV disease entirely. Free fuck book near me Rozelle. Interventions to prevent HIV transmission should notably be directed at HIV negative and oblivious MSM and arouse timely HIV testing (i.e., after risk events or when experiencing symptoms of seroconversion illness) as well as routine testing when sexually active.
Because determinations on UAI seem to be partially based on sensed HIV concordance, accurate knowledge of one's own and the partner's HIV status is important. In HIV negative men and HIV status-unaware guys, decisions on UAI WOn't only be based on perceived HIV status of the partner but also on one's own negative status. HIV serosorting is challenged by the frequency of HIV testing and also the HIV window phase during which individuals can transmit HIV but cannot be diagnosed with the commonly used HIV tests. Hence serosorting can't be regarded as an extremely successful method of averting HIV transmission 22 Besides interventions to trigger the uptake of HIV and STI testing in sexually active men, interventions to warn against UAI based on sensed HIV negative concordant status are in order, irrespective of whether this concerns online or offline dating.
For HIV-oblivious guys the impact of dating place on UAI did not change by adding partner features, but it increased when adding lifestyle and drug use. It is hard to assess the real risk for HIV for these men: do they act as HIV negative guys that want to shield themselves from HIV infection, or as HIV positive men attempting to safeguard their HIV negative partner from HIV infection? A study by Horvath et al. reported that 72% of guys who were never tested for HIV, profiled themselves online as being HIV-negative, which might be problematic if they're HIV-positive and participate in UAI with HIV-negative partners 12 Formerly Matser et al. reported that 1.7% of the oblivious and perceived HIV negative MSM were analyzed HIV-positive. The study population comprised the MSM reported in this study 15
Online dating wasn't correlated with UAI among HIV-negative guys, a finding in agreement with some previous studies, mainly among young men 21 , but in contrast with other studies 1 - 5 This may be because of the fact that most earlier studies compared sexual behavior of two groups of MSM rather than comparing two sexual behavior patterns within one group of men. Yet it can also represent secular changes; possibly in the beginning of online dating a more high-risk group of men used the Internet, and over time online dating normalized and less high-risk MSM nowadays also use the Net for dating. Free fuck book closest to Rozelle New South Wales Australia.
A key strength of this study was that it explored the relationship between online dating and UAI among MSM who had recent sexual contact with both online and also offline casual partners. Rozelle, New South Wales Free Fuck Book. Free Fuck Book Near Me Annandale New South Wales. This averted bias due to potential differences between guys just dating online and those just dating offline, a weakness of numerous previous studies. Free fuck book nearby Rozelle Australia. By recruiting participants at the biggest STI outpatient clinic in the Netherlands we could comprise a lot of MSM, and avoid potential differences in guys tried through Internet or face-to-face interviewing, weaknesses in certain previous studies 3 , 11
Among HIV positive men, in univariate analysis UAI was reported significantly more frequently with on-line partners than with offline associates. When correcting for associate characteristics, the effect of online/offline dating on UAI among HIV-positive MSM became somewhat smaller and became non-significant; this suggests that differences in partnership factors between online and also offline partnerships are accountable for the increased UAI in online established partnerships. This might be because of a mediating effect of more information on partners, (including perceived HIV status) on UAI, or to other variables. Among HIV negative guys no effect of online dating on UAI was found, either in univariate or in any of the multivariate models. Among HIV-oblivious guys, online dating was associated with UAI but just significant when adding associate and venture variables to the model.
In this large study among MSM attending the STI clinic in Amsterdam, we found no signs that online dating was independently associated with a higher risk of UAI than offline dating. For HIV-negative guys this dearth of assocation was clear (aOR = 0.94 95 % CI 0.59-1.48); among HIV positive men there was a nonsignificant association between online dating and UAI (aOR = 1.62 95 % CI 0.96-2.72). Simply among guys who indicated they weren't conscious of their HIV status (a little group in this study), UAI was more common with online than offline associates.
The number of sex partners in the preceding 6months of the index was also connected with UAI (OR = 6.79 95 % CI 2.86-16.13 for those with 50 or more recent sex partners compared to those with fewer than 5 recent sex partners). Free fuck book near me Rozelle. UAI was significantly more likely if more sex acts had occurred in the partnership (OR = 16.29 95 % CI 7.07-37.52 for >10 sex acts within the venture compared to only one sex act). Other factors significantly associated with UAI were group sex within the venture, and sex-related multiple drug use within partnership.
In multivariate model 3 (Tables 4 and 5 ), additionally including variables concerning sexual behaviour in the venture (sex-associated multiple drug use, sex frequency and partner kind), the independent effect of online dating location on UAI became somewhat stronger (though not essential) for the HIV positive guys (aOR = 1.62 95 % CI; 0.96-2.72), but remained similar for HIV-negative guys (aOR = 0.94 95 % CI 0.59-1.48). The result of online dating on UAI became more powerful (and significant) for HIV-oblivious men (aOR = 2.55 95 % CI 1.11-5.86) (Table 5 ).
In univariate analysis, UAI was significantly more likely to happen in online than in offline ventures (OR = 1.36 95 % CI 1.03-1.81) (Table 4 ). The self-perceived HIV status of the participant was firmly connected with UAI (OR = 11.70 95 % CI 7.40-18.45). The impact of dating place on UAI differed by HIV status, as can be seen best in Table 5 Table 5 shows the association of online dating using three different reference groups, one for each HIV status. Among HIV positive guys, UAI was more common in online in comparison to offline ventures (OR = 1.61 95 % CI 1.03-2.50). Among HIV negative men no association was apparent between UAI and online ventures (OR = 1.07 95 % CI 0.71-1.62). Among HIV-oblivious men, UAI was more common in online when compared with offline partnerships, though not statistically significant (OR = 1.65 95 % CI 0.79-3.44).
Characteristics of online and offline partners and partnerships are revealed in Table 2 The median age of the partners was 34years (IQR 28-40). Compared to offline partners, more online partners were Dutch (61.3% vs. 54.0%; P 0.001) and were defined as a known partner (77.7% vs. 54.4%; P 0.001). The HIV status of online partners was more often reported as understood (61.4% vs. 49.4%; P 0.001), and in on-line ventures, perceived HIV concordance was higher (49.0% vs. 39.8%; P 0.001). Participants reported that their online partners more often knew the HIV status of the participant than offline partners (38.8% vs. 27.2%; P 0.001). Participants more frequently reported multiple sexual contacts with online partners (50.9% vs. 41.3%; P 0.001). Sex-related substance use, alcohol use, and group sex were less often reported with internet partners. Free Fuck Book Near Me Kensington New South Wales.
To be able to analyze the possible mediating effect of more info on partners (including perceived HIV status) on UAI, we developed three variant models. In version 1, we adapted the association between online/offline dating place and UAI for characteristics of the participant: age, ethnicity, number of sex partners in the preceding 6months, and self-perceived HIV status. In model 2 we added the partnership characteristics (age difference, ethnic concordance, lifestyle concordance, and HIV concordance). In version 3, we adapted additionally for partnership sexual risk behaviour (i.e., sex-associated drug use and sex frequency) and partnership kind (i.e., casual or anonymous). As we assumed a differential effect of dating location for HIV positive, HIV-negative and HIV status unknown MSM, an interaction between HIV status of the participant and dating location was included in all three models by making a fresh six-class variable. For clarity, the effects of online/offline dating on UAI are also presented individually for HIV-negative, HIV positive, and HIV-unaware guys. We performed a sensitivity analysis confined to partnerships in which just one sexual contact occurred. Statistical significance was defined as P 0.05. No adjustments for multiple comparisons were made, in order not to miss potentially important organizations. As a rather large number of statistical tests were done and reported, this approach does lead to an elevated danger of one or more false-positive associations. Evaluations were done utilizing the statistical programme STATA, version 13 (STATA Intercooled, College Station, TX, USA).
Before the analyses we developed a directed acyclic graph (DAG) representing a causal model of UAI. In this model some variants were putative causes (self-reported HIV status; on-line partner acquisition), others were considered as confounders (participants' age, participants' ethnicity, and no. of male sex partners in preceding 6months), and some were assumed to be on the causal pathway between the principal exposure of interest and results (age difference between participant and partner; ethnic concordance; concordance in life styles; HIV concordance; partnership sort; sex frequency within venture; group sex with partner; sex-associated substance use in venture).
We compared characteristics of participants by self-reported HIV status (using 2-evaluations for dichotomous and categorical variables and using rank sum test for continuous variables). We compared features of participants, partners, and partnership sexual behavior by on-line or offline partnership, and calculated P values based on logistic regression with robust standard errors, accounting for linked data. Continuous variables (i.e., age, number of sex partners) are reported as medians with an interquartile range (IQR), and were categorised for inclusion in multivariate models. Random effects logistic regression models were used to analyze the association between dating place (online versus offline) and UAI. Free Fuck Book in Rozelle, New South Wales. Odds ratio tests were used to evaluate the significance of a variable in a model.
As a way to explore potential disclosure of HIV status we also asked the participant whether the casual sex partner understood the HIV status of the participant, together with the answer options: (1) no, (2) maybe, (3) yes. Sexual behavior with each partner was dichotomised as: (1) no anal intercourse or simply shielded anal intercourse, and (2) unprotected anal intercourse. To discover the subculture, we asked whether the participant characterised himself or his partners as belonging to one or more of the subsequent subcultures/lifestyles: casual, formal, substitute, drag, leather, military, sports, trendy, punk/skinhead, rubber/lycra, gothic, bear, jeans, skater, or, if not one of these characteristics were related, other. Concordant lifestyle was categorised as: (1) concordant; (2) discordant. Casual partner sort was categorised by the participants into (1) known traceable and (2) anonymous partners.
HIV status of the participant was obtained by asking the question 'Do you understand whether you're HIV infected?', with five answer choices: (1) I am definitely not HIV-infected; (2) I think that I am not HIV-contaminated; (3) I do not understand; (4) I think I may be HIV-infected; (5) I know for sure that I 'm HIV-contaminated. We categorised this into HIV-negative (1,2), unknown (3), and HIV positive (4,5) status. The survey enquired about the HIV status of every sex partner with the question: 'Do you understand whether this partner is HIV-contaminated?' with similar reply options as previously. Perceived concordance in HIV status within partnerships was categorised as; (1) concordant; (2) discordant; (3) unknown. The last category represents all partnerships where the participant didn't understand his own status, or the status of his partner, or both. In this study the HIV status of the participant is self-reported and self-perceived. The HIV status of the sexual partner is as perceived by the participant.
Participants completed a standardised anonymous survey during their visit to the STI outpatient clinic while waiting for preliminary test results after their consultation using a nurse or doctor. The questionnaire elicited information on socio-demographics and HIV status of the participant, the three most recent partners in the preceding six months, and information on sexual behaviour with those partners. A detailed description of the study design as well as the questionnaire is supplied elsewhere 15 , 18 Our primary determinant of interest, dating location (e.g., the name of a bar, park, club, or the name of a website) was obtained for every partner, and categorised into online (websites), and offline (physical sites) dating locations. To simplify the terminology of recognizing the partners per dating place, we refer to them as on-line or offline partners.
We used data from a cross sectional study focusing on spread of STI via sexual networks 15 Between July 2008 and August 2009 MSM were recruited from the STI outpatient clinic of the Public Health Service of Amsterdam, the Netherlands. Men were eligible for participation if they reported sexual contact with men during the six months preceding the STI consultation, they were at least 18years old, and might comprehend written Dutch or English. People could participate more than once, if following visits to the practice were related to a potential new STI episode. Free Fuck Book near Rozelle New South Wales. Participants were routinely screened for STI/HIV according to the standard procedures of the STI outpatient clinic 15 , 17 The study was approved by the medical ethics committee of the Academic Medical Center of Amsterdam (MEC 07/181), and written informed consent was obtained from each participant. Free fuck book near Rozelle. Included in this analysis were men who reported sexual contact with at least one casual partner dated online as well one casual partner dated offline.